Impact of prehospital IV furosemide or nitrate application on hospital outcome in acute heart failure patients.

OBJECTIVES: This study aims to evaluate the association between prehospital intravenous therapy and clinical outcomes in the patients with acute heart failure.

METHODS: We conducted a prospective, multicenter observational study of consecutive AHF patients. Univariate and logistic regression analysis were performed to determine association between prehospital furosemide or nitrates administration and hospital outcome (death, length of stay).

RESULTS: Data on a total of 1239 patients were processed. The mean age in the whole cohort was 71 ± 11.8 years with a gender distribution (M/F) of 634/605 patients. By prehospital treatment whole cohort was divided into 4 groups: F+ group with prehospital IV furosemide administration of 602 patients (48.6 %), F- group without prehospital IV furosemide administration of 637 patients (51.4 %), N+ group with prehospital IV nitrates administration of 110 patients (8.9 %) and N- group without IV nitrates administration of 1129 patients (91.1 %). Group of combined F+/N+ was not created. Ninety-four patients (7.6 %) died during the index hospitalization. Hospital mortality (p = 0.138) and length of stay (p = 0.101) did not differ in F+ vs F-. The patients with prehospital nitrates administration did not differ in mortality, but a shorter length of stay in univariate analysis (p = 0.03) was recorded. After adjusting for age, systolic BP and mode of referral to hospitalization, early IV furosemide usage nor nitrates showed no impact on hospital mortality and length of stay.

CONCLUSIONS: Prehospital treatment with IV furosemide or nitrates in AHF patients seemed to have no major impact on hospital mortality or length of hospitalization after adjustment for several cofounders (Tab. 2, Ref. 16).